Death by Request (Caribbean Murder #11)

“Was Tara healthy?” Mattheus asked suddenly.

“Yes, Tara was basically healthy,” said Dr. Padden, “and it was our job to keep her that way. We watched for infections such as pneumonia and bedsores, and made sure she had balanced nutrition daily. The nursing staff moved her every two to three hours from side to side. Some comatose patients are even put in a chair. The goal is to move the patient as much as possible.”

Mattheus was amazed by the intricacy of all that had to be done. He could only imagine how confusing and frustrating the situation could be.

“We also have to keep the patient from hurting themselves,” Dr. Padden continued. “They can become restless, thrash around and even pull on tubes or dressings. Wrist restraints may be put on or medicine given to calm them down. Sometimes side rails on the bed have to be up to prevent the patient from falling.”

“Did that happen to Tara?” asked Mattheus horrified, “was she restless, did she toss around, pull on her tubes?”

“Once or twice she did, as I recall,” said Dr. Padden.

“Was she trying to tell you something by behaving that way?” Mattheus couldn’t help ask.

Dr. Padden shook his head strongly. “Absolutely not,” he insisted. “A tremendous danger in working with comatose patients is assuming their behavior means something. It doesn’t. These are reflex behaviors made in response to bodily discomfort. The unconscious part of the brain does what it does, but it’s beyond the patient’s control.”

“I see,” said Mattheus.

“I’m glad you do,” replied Dr. Padden. “So many interpret every little move or grimace the patient makes. It’s common for the family to claim that the patient is trying to communicate with them, or that they’re about to wake up. It’s very difficult to disabuse them of that idea, too.”

“I’m sure it is,” said Mattheus, “I can see how hard it must be sitting there, waiting.”

“Excruciating,” Dr. Padden agreed, “and often the patient looks as though they’re about to return. And, of course, some do. When that happens they come back little by little.”

“What were Tara’s chances of returning?” Mattheus asked bluntly then.

“It’s hard to say what her chances were,” Dr. Padden began tapping his fingers on his legs.” Some come out, some progress to a vegetative state and others die. Some recover a life, others do not. Some go on to regain a degree of awareness, others remain in a vegetative state for years or even decades. The longest case recorded or remaining in a vegetative state was forty two years.”

“Oh God,” said Mattheus, “forty two years of living in a fog.”

“Some people in deep coma recover well while others in a so-called milder coma sometimes fail to improve. Some people come out fine, others with with significant impairments. Only time shows us what will happen,” said Dr. Padden.

“This is a tough situation,” said Mattheus, “a hard call what to do.”

“Nothing to do but wait,” Dr. Padden commented. “Patience is the best medicine here.”

Mattheus was startled to realize that it was in the realm of possibility that Tara could have lived. “You were all hoping that Tara would regain full awareness weren’t you?” he asked.

“Of course we were,” said Dr. Padden. “Everyone always hopes that. And it can be subtle. In the first days, patients may awake only for a few minutes, then the length of time awake gradually increases. A person with a low predicted chance of recovery may still awaken and do well. I tell that to the families, but they don’t listen.”

“I can understand why not,” said Mattheus.

“So can I,” said Dr. Padden.

Mattheus felt momentarily shaken. Who could bear living with the unknown? He understood why people wanted probabilities, something to hold onto.

“According to statistics, what were Tara’s chances?” Mattheus asked.

“Tara was in a coma for two months. The chance of full recovery was very low, but still possible,” Dr. Padden replied.

“But she wasn’t about to die, either,” said Mattheus. He had to focus on the immediate cause of her passing.

“There was immediate reason to assume that,” said Dr. Padden. “Patients die in comas due to infection, difficulty breathing, pneumonia, etc. Tara was healthy.”

“No sign of brain death, either?” Mattheus wanted total certainty.

Dr. Padden seemed irritated by the question. “Many place a great deal of importance on the idea of “brain death” because most people equate brain death with death of the individual. But according to some researchers, death is characterized by irreversible cessation of all vital functions, circulation, respiration, and consciousness. For example, although a patient may be “brain dead”, they may still be considered alive because they can still grow and even reproduce.”

Mattheus was stunned by his response. “So you considered Tara fully alive?” he asked.